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Member Healthcare FAQ

RMHP offers a variety of plans, so the answers below may differ depending on the RMHP plan through which you receive your benefits. For additional information, see your plan materials or contact Customer Service.

Customer Service
Q:
How do I contact Customer Service?

A:
You can call Customer Service 8:00 a.m. to 5:00 p.m., Mountain Time, M-F at 970-244-7912 or 888-282-1420 (TTY: 711). Alternatively, you can send an Email to customer_service@rmhp.org

General Questions
Q: 
How do I appeal a decision made by RMHP?

A: If a Member disagrees with a decision made by RMHP and wants to appeal the decision, they must use the Dispute Resolution Procedures described in the Health Plan Guide. These procedures vary depending on your RMHP plan.

My Benefits
Q:
  Where can I get a summary of my benefits?

A:  After enrolling in an RMHP plan, the subscriber will receive a Health Plan Guide that includes a summary of benefits. If you need a replacement Health Plan Guide, you may contact Customer Service.

Q:  How do I add members of my family to my plan?

A:  There are time limits for making changes to your coverage, such as adding your spouse or other dependents to your plan. See your Health Plan Guide for time limits. If you have a group plan, you can obtain a change form from your employer. Individual plan subscribers can contact RMHP Customer Service.

Q:  Can I move outside of Colorado and still keep my benefits?

A:  Except for Members enrolled on an Indemnity or PHCS plan, eligible under any continued coverage through COBRA, or dependent children, Members who do not reside in the service area are not eligible to receive any benefits. The requirements and service area vary depending on your RMHP plan.

Q: Which services require preauthorization?

A: Referrals are not required; however, certain health care procedures and services must be preauthorized by RMHP before you receive them, or you may not get the maximum level of coverage your plan allows. When you see a participating provider, your doctor gets the necessary preauthorization for you. For services provided by a non-participating provider, it is your responsibility to start the preauthorization process. Failure to have services preauthorized when required will result in a significant reduction in benefits, as described in your Health Plan Guide. View the list of services requiring preauthorization.

To ensure your preauthorization request is completed in a timely manner, please allow:

Medicaid

10 days

Medicare

14 days

CHP+

15 days

Commercial

15 days

Claims

Q: What is Coordination of Benefits (COB)?

A: Coordination of Benefits (COB) happens when a person has health care coverage under more than one health plan.  Refer to your Health Plan Guide for COB provisions and be sure to notify RMHP if you or a covered family Member has medical coverage with another health plan.

Copayments and Deductibles
Q:
How do I know how much I need to pay for health care services?

A: The subscriber receives a Coverage Schedule that shows how much you pay for the covered health care services listed in the Schedule of Benefits in the Health Plan Guide. It also shows benefits that are limited to a number of treatments, days, visits, or a specific dollar amount.  This information for most commonly used services is also accessible in access|RMHP our secure website for Members.  Registration is required.

Q: What is a Member Billing Statement (MBS)?

A: A Member Billing Statement (MBS) lists the health care services you've received and any deductibles or copayments due to RMHP. You will receive a Member Billing Statement (MBS) only when you have received services for which RMHP has already paid the provider in full and for which you must pay your copayment directly to RMHP.

A: What is an Explanation of Benefits (EOB)?

Q: You will receive an Explanation of Benefits (EOB) each time you receive services from a provider who is responsible for collecting your copayment. You will also receive one if you have medical coverage with another health plan. If you have questions about your copayments, coinsurance, or deductibles, the amounts can be found in the Coverage Schedule section of your Health Plan Guide.

Additional Resources for Members

Colorado Division of Insurance
Colorado Division of Insurance, Board of Examiners
Colorado Health Guide
Colorado Quitnet
Colorado Health Online (CBGH)
Mail Order Pharmacy or Online Pharmacy Refills
Leapfrog Group Hospital Quality and Safety Survey Results
US Dept of Health & Human Services Hospital Compare
Medicare Quality Care Finder
Preparing for Natural Disasters
Healthwise Knowledge Base

Other Available FAQ's

Medicare Healthcare FAQ
Broker FAQ